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The overall goal of this project was to improve youth’s sexual and reproductive health through community participation. To this end, Advocates for Youth worked with Mwangaza Action, a Burkinabé nongovernmental organization (NGO), and three youth associations in southern Burkina Faso, building their capacity regarding 1) youth’s reproductive and sexual health and 2) community participation. Together over 1.5 years, the partners mobilized 20 villages to identify priority issues with respect to adolescents’ reproductive and sexual health and strategies to address these priorities. As a result, communities launched interventions that ran for the remaining year and a half of the project. [In addition, many of the activities still continue today.] The community participation methodology was the basis for the program. The methodology utilized a series of participatory workshops, carried out with village committees composed of girls and boys and adult women and men. Other aspects of the methodology included village assemblies, regular meetings with local authorities, focus group research, and action planning.
As a result of the community mobilization process, boys and girls, supported by village elders, identified priorities that included:
- Lack of information on: 1) sexually transmitted infections (STIs), including HIV, 2) family planning, and 3) female genital mutilation;
- Infrequent use of reproductive health services; and
- Lack of parent child communication.
The strategies identified to address these priority concerns included:
- Peer education;
- Activities to improve parent child communication;
- Information, education and communication (IEC) activities, including theatre, dance, and public video showings and discussions; and
- Implementation of youth-friendly reproductive health services.
Youth associations, assisted by village committees, trained a total of 47 peer educators ages 15 to 25 (about half were female and half male). Overall each month, the peer educators led about 80 group talks and made 160 home visits, focusing on topics that communities had identified as priorities. Each month, the peer educators sold about 330 condom packets (each packet contained 4 condoms) and reached about 1,760 youth.
IEC activities were essential to the success of the project as they created an enabling and empowering environment. Assisted by the village committees, youth association members led about 45 topic-specific discussions in each of the three sites every month. These discussions were open to all villagers and usually featured a video or theatre performance, often accompanied by music and dance. Members of the youth associations also made about 90 home visits each month, meeting with village adults and focusing on parent-child communication around sexual health and sexuality issues. As a result of the IEC activities and home visits, the project reached about 3,780 youth and 2,070 adults each month across the sites.
In response to the need for more youth-friendly services, Advocates and Mwangaza led a five-day training workshop for health center personnel from the three sites on how to make their services friendly and welcoming to young people. Two sites thereafter designated one person whose special focus was to oversee youth services. All three sites adjusted their operating hours to better suit youth’s needs. Two of the sites designated a space just for youth. The third site rearranged counseling space to maximize confidentiality. Later, health center staff at one of the three sites replicated the training for other health personnel in that village, and the training has since been replicated in the other two sites.
Knowledge, Attitudes, & Behaviors (KAP) Evaluation Results
Highlights below are drawn from the project evaluation, conducted by the Pacific Institute for Women’s Health. These include results from a KAP survey, conducted to measure changes across time resulting from this community-based intervention.
- Results regarding knowledge and beliefs showed increases in the proportion of youth:
- Reporting that they felt able to talk to their parents about sexuality issues (up from 36 to 55 percent);
- Showing improved knowledge about HIV (rising from 70 to 86 percent);
- Knowing how to use a condom correctly (up from 52 to 84 percent);
- Not intending to excise future female children (up from 72 to 86 percent); and
- Aware of where to obtain health services (up from 62 to 78 percent).
“In any case, before we were scared of going to the health centers because we felt ashamed but also because of the reception of the health center staff. But now it’s even become our number one place to seek all that we want to know about sexuality and health.”
- a young person during a focus group discussion
- Results regarding behavior showed:
There was no change in age at first intercourse, which remained steady at about 18 years. At the same time, evaluation showed that a larger proportion of young women reported being sexually active (up from 24 to 38 percent). Qualitative research later demonstrated that this apparent increase in sexual activity among young women arose from a greater openness in admitting to sexual activity.
- A decreased proportion of sexually active youth reporting multiple sexual partners;
- An increased proportion of sexually active youth reporting only one partner (increased in two of the three sites; up from 47 to 67 percent);
- An increased proportion of sexually active youth reporting current condom use (up from 51 to 73 percent); and
- An increased proportion of sexually active youth in only one of the three sites reporting current contraceptive use.
For me the condom is not just something for the boys. With these diseases that we have now, I always have my condom in my purse. This way, if my boyfriend says that he does not have a condom when we are going to make love and that we have to do it without it, I just say no, because I have one.
- a young woman in Pama
Changes in Organizational Capacity
Evaluation showed important improvements in the capacity of local partners to implement participatory reproductive and sexual health programs for youth.
- The youth associations developed capacity in community participation and facilitation techniques, organizational development, and reproductive and sexual health. The youth associations have become well known for their work on youth’s reproductive and sexual health issues and are often asked to assist local and some national organizations.
- Mwangaza developed capacity in regard to youth’s reproductive and sexual health. [Mwangaza already had a great deal of expertise in community mobilization.] Mwangaza has also gained recognition at the national and international level for its capacity to implement reproductive and sexual health programs for youth—an asset that Mwangaza previously lacked.
The administrative representative of a neighboring village [15 km away] participated in one of the video showings and discussions in Pama on HIV and AIDS. At the event’s end, he approached youth association members and said, “Why can’t you come do a session like this in my village? Or, do you think that we don’t have any problems?”
Achievements in Levels of Community Participation
The project achieved high levels of participation by community members. Seventy percent of those interviewed had participated in some project activity. Perhaps even more important, youth achieved meaningful participation. For example, 78 percent of respondents perceived young people ages 16 through 21 as key actors in the project. Seventy percent of respondents indicated that parents and other adults played consultative or observational roles. The project provided frequent opportunities to participant to a wide range of leaders, service providers, community members, parents and youth.
For example in Pama, the governing committee of the Center for Reading and Culture offered the Pama youth association the use of a conference room for the trainings and meetings.
Several key elements inherent in the program’s design are worth noting. These include:
- Youth and community members actively participating in designing the program;
- Youth working in partnership with adults;
- Local organizations developing and increasing their capacities;
- Local knowledge and expertise converging with research-based, effective reproductive and sexual health strategies;
- Communities harnessing their own technology and other assets
- Youth organizations involving entire communities in group discussions
- Focus on the gender- and age-specific needs of youth
- Consistent focus on achieving gender parity in youth’s and adults’ involvement
- Focus on achieving multi-sector community buy-in
The program encountered challenges in several areas. Problem areas that could be improved include:
- Mechanisms for the youth associations to accumulate, track, and report data regarding their work
- Mechanisms for tracking peer educators’ referrals to health centers
- Coordination with evaluation partners
- Supervision of peer educators and oversight training for their supervisors
- Motivational mechanisms for village committee members and peer educators
- Links to livelihoods programs.
Using a community participation approach allows programs to serve youth better. Community participation means: 1) involving youth and adult community members, including parents, teachers, religious leaders, and health service providers; and 2) creating an enabling environment that will encourage young people to take charge of their own reproductive and sexual health.
For further information about the program, please contact:
Director, International Division
Advocates for Youth
2000 M Street, NW, Suite 750
Washington, DC 20036
Tel: 202 419 3420, ext. 32
Fax: 202 419 1448
06 BP 9277
Ouagadougou, Burkina Faso
Tel: (226) 36 07 70 / 36 33 85
Fax: (226) 36 33 85